title: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy and right-to-left shunt: lack of evidence for an association in a prevalence study.
abstract: OBJECTIVE
  Up to more than 50% of cryptogenetic stroke patients and patients with migraine with aura (MA) are found to have a right-to-left shunt (RLS), which is usually due to a patent foramen ovale. Moreover, both MA and stroke are cardinal features of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL). Notch3 mutations have been suggested to induce an abnormally high incidence of atrial septal defects in a family harbouring an Arg141Cys pathogenetic mutation. We sought to determine the prevalence of RLS in CADASIL patients with different Notch3 mutations, both with and without migraine as a clinical feature.
  
  
  METHODS
  Subjects with a molecular diagnosis of CADASIL were tested for the presence of an RLS by means of contrast-enhanced transcranial Doppler (TCD). The diagnosis of migraine was made according to the 2004 International Headache Classification.
  
  
  RESULTS
  Sixteen CADASIL patients were tested; 6 had MA. Four patients displayed an RLS on contrast-enhanced TCD examination. Three of these patients had MA. Both patients with Arg141Cys displayed a large RLS.
  
  
  CONCLUSIONS
  We conclude that RLS is not necessarily linked to CADASIL as a comorbidity factor. Nevertheless, there could be a relation between RLS and specific Notch3 mutations, such as Arg141Cys.
authors.affiliation: Department of Neurological and Visual Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy. sara.mazzucco@univr.it
authors.forename: S
authors.initials: S
authors.lastname: Mazzucco
authors.forename: G P
authors.initials: GP
authors.lastname: Anzola
authors.forename: M
authors.initials: M
authors.lastname: Ferrarini
authors.forename: F
authors.initials: F
authors.lastname: Taioli
authors.forename: S
authors.initials: S
authors.lastname: Olivato
authors.forename: A P
authors.initials: AP
authors.lastname: Burlina
authors.forename: G M
authors.initials: GM
authors.lastname: Fabrizi
authors.forename: N
authors.initials: N
authors.lastname: Rizzuto
mesh_terms: D000328:Adult; D000368:Aged; D046589:CADASIL / Q000150:complications* / Q000453:epidemiology / Q000235:genetics; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000150:complications* / Q000453:epidemiology; D009154:Mutation; D015995:Prevalence; D000071656:Receptor, Notch3; D051880:Receptors, Notch / Q000235:genetics; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: C499374:NOTCH3 protein, human; D000071656:Receptor, Notch3; D051880:Receptors, Notch